Provider Update Newsletter

August 2000, Volume 94

DHS Website
Reminders
HIPAA Happenings

GPA Claims

Medical Assistance Hysterectomy Statement/Rhode Island Medical Assistance Consent Form for Sterilization Procedures

TOBI Inhalation Solution Billing

DHS Web Site

DHS has made some big changes in its Web site and we encourage you to check it out!   You may also forward any questions you may have about DHS programs and operations to the Webmaster.

Reminders

A. Please include your Medical Assistance Provider number on all correspondence that is sent to EDS.

B. Group providers need to use the Group Provider Agreement Form when enrolling attending performing providers as members to that group.

C. When sending in a Provider Refund the following must be attached to the check:

• Copy of the Remittance Advice (RA) with the ICN (15 digit internal control number used to identify the claim, which can be retrieved from the Customer Service Help Desk) and recipient highlighted

• The correct Medical Assistance Provider number

If the copy of the Remittance Advice is not available the following information is needed:

• Recipient name and Medical Assistance Identification Number

• Medical Assistance Provider number

• ICN

If this information is not included with the Provider Refund Check, it will result in a Non-Claim Specific Refund. A non-claim specific refund will be posted on your RA under the financial items section. It will not indicate an ICN, recipient information, or dates of service. All refund checks should be made payable to State of Rhode Island and mailed to:

EDS Refunds
PO Box 2010
Warwick, RI 02887-2010

Questions can be directed to the Customer Service Help Desk at
(401) 784-8100 for local and long distance callers, or 1-800-964-6211 for
in-state toll calls and bordering communities.

HIPAA Happenings

DHS and EDS staff recently attended HIPAA technical training sponsored by HCFA. The sessions focused on the new electronic transaction standards that will replace currently used formats. The public will have an opportunity to comment on the new transaction sets until August 2000, at which time the two-year implementation phase will begin. The following transaction sets have been defined and approved by HCFA and the applicable Standards Development Organization. Use of the new electronic transaction sets will be mandatory for all health care insurers, carriers, providers and clearinghouses.

Transaction Type	ASC X12 Standard
Claim – Professional	837
Claim – Institutional	837
Claim – Dental	837
Claim – Pharmacy	NCDCP
Remittance Advice	835
Claim Status	276/277
Health Plan Enrollment	834
Eligibility Inquiry	270/271
Premium Payment	820
Service Authorizations	278

DHS and EDS will also be holding training sessions later this year, however, we strongly encourage you to visit the following Web sites in order to become familiar with the new standards and to begin planning your strategies for implementation.

We will also begin publishing FAQ’s (frequently asked questions) in the monthly Provider Update as they are received. You may forward questions to either the MMIS Systems & Data Unit at DHS, 600 New London Avenue, Cranston, 02920, or to EDS Provider Relations, 1471 Elmwood Avenue, Cranston, 02910, or, through this site.

www.hcfa.gov - HCFA’s home site; HIPAA page

www.wpc-edi.com - Washington Publishing Company; the manuals and implementation guides for new transaction sets

www.ehnac.org - Electronic Healthcare Network Accreditation Commission

www.ps-tag.org - Private Sector Technical Assistance Group; white papers on HIPAA financial considerations

www.rx2000@rx2000.org - listserv group featuring daily discussions about HIPAA policy and implementation

www.disa.org - Data Interchange Standards Association; HIPAA page

www.wedi.org - Workgroup for Electronic Data Interchange; HIPAA page

http://aspe.os.dhhs.gov/admnsimp/faqtx.htm - US Dept. of Health and Human Services Web site; frequently asked questions concerning HIPAA standards and implementation

GPA Claims

As you are aware, we have transitioned GPA claims processing to EDS for claims with dates of service effective May 1, 2000. We ask that you submit claims with dates of services prior to May 1, 2000 to DHS as soon as possible so that we can streamline the payment process by having one system in place. Thanks for your cooperation.

Medical Assistance Hysterectomy Statement/Rhode Island Medical Assistance Consent Form for Sterilization Procedures

In order for EDS to validate that your Medical Assistance patient has given consent to a sterilization or hysterectomy procedure, we ask that you indicate the Medical Assistance Identification Number (MID/SS#) on the top right portion of the consent form. This will allow for EDS to identify the patient within our system.

On the Federal Sterilization Form the name is to be printed by the patient in the column titled, "Consent to Sterilization", with the exception of the field requiring a signature.

The Medical Assistance Hysterectomy Statement has only one field for the patient’s signature. Please print the patient’s name on this form as well.

We appreciate your cooperation in these matters that will result in a more expedient process to adjudicate your claims.

TOBI Inhalation Solution Billing

When billing for TOBI Inhalation Solution manufactured by Pathogenesis Inc. NDC 63430 - 0065 - 01 please bill by the milliliter not the ampule. There are 56 ampules each containing 5 mls of Tobramycin Solution for Inhalation in a box for a total of 280 mls. Please bill using mls in order to receive the correct reimbursement.